Gonococcemia

GONOCOCCEMIA, gonococcaemia, gono-septicemia, gonosepsis, gonemia—these are terms used by various authors, but they all denote the same disease, which can be characterized as a general gonococcal infection of the body—gonococcal sepsis. The modern view of G. is that gonococci, detectable in the general bloodstream through appropriate cultures, only enter the blood from some specific focus, but do not multiply in it. Gonococci enter the blood from organs located mainly on the path of blood circulation, such as from the heart valves in acute gonococcal endocarditis. The clinical course of the disease is always associated with the focus of infection, i.e., in most cases with acute gonococcal endocarditis, and is accompanied by general severe condition, severe shortness of breath, palpitations, and septic temperature. In such cases, the temperature gives a curve characteristic of septic processes, with variations of 2-3-4°, and this curve is not accompanied by any regularity, and the increase in t^d can occur at any hour and sometimes even several times a day. A sharp drop in temperature is always accompanied by profuse sweating and very severe weakness. Sometimes G., in the presence of acute gonococcal endocarditis, is not prolonged; after 2-3 weeks the temperature normalizes, patients begin to recover, and the process in such cases takes the form of an acute febrile disease of unknown etiology, simulating typhoid, malaria, etc. Diagnostic difficulties are also possible because in gonococcemia, rashes in the form of urticaria, roseola, papules, sometimes hemorrhagic eruptions, are occasionally observed. But often some time after the first attack, the disease recurs again, very severe cardiac phenomena with septic fever already definitely indicate the presence of endocarditis, and in such cases the diagnosis becomes more or less possible. In G., there may be several such attacks over several months and even a year. More often, however, the disease is limited to one attack, which lasts several weeks, sometimes up to 1½-2 months, and in most cases leads to a fatal outcome. In general, gonococcemia with the described phenomena and fatal outcome is a rather rare phenomenon: in Moscow in 1925-27, among 26,400 autopsies, only four cases of gonococcemia were encountered. The diagnosis of acute endocarditis and sepsis is not difficult, but the diagnosis of gonococcal endocarditis and G. is not always possible, since gonococci in blood cultures do not always give a positive result. In most published cases, G. was determined only after death—either by blood cultures or bacterioscopically by means of smears from deposits on the endocardium. At autopsies, parenchymal organs are most often found to be fatty-degenerated, as in any septic diseases. On the side of the heart valves, especially the aorta, a picture of thrombo-ulcerative endocarditis is found, sometimes with severe destruction of the valve substance. The presence of articular lesions, especially those characteristic of gonococcal arthritis, significantly helps in the diagnosis (see Gonococcal Arthritis). Gonococcal urethritis or exacerbation thereof, preceding G., as well as specific lesions of the sex glands, especially the seminal vesicles, sometimes give definite indications of the nature of the sepsis. The Bordet-Gengou reaction with gonococcal antigen, according to some authors, gave a positive result. Treatment of G. is related to treatment of the focus of bacteremia and therefore should most often be directed at acute gonococcal endocarditis. There are no specific means for acute gonococcal endocarditis, since all specific means for gonococcal diseases are based on the principles of irritation, and in acute endocarditis, rest—general and local—for the heart is primarily necessary. Consequently, gonococcal vaccine and other immunizing preparations are not indicated. Infusions of collargol and electargol usually do not give success, and these types of preparations apparently also have irritating properties. Infusions of physiological NaCl solution are often used. Preparations for increasing cardiac activity, especially digitalis, are very valuable for treatment. (See also Gonorrhea.)